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o Surgicol procedures lncluding Minimol Access procedures

Gostrointestinol SurgerY

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Discussion

Limitations to this. approach include advanced peritonitis, dense adhesions, and so on- --- **'
Procedure
Pneumoperitoneum and ports are established as for Lapa_roscopicVasglg-v (see, p._ 108).-ii;;;;ilolory is as_ sessed, and fluid is aspiratid peritoneal cavitv may i,".i".iJul"J. .""t ioi'cuft,rre. the "".i Cii ration i"q closed-wirh "i" lf rfre perfoomental patch is then.stapled'or,rl;;;;ieasible. An ""aor"8pi.".ffi;#; the the perforation. The t"..""-"-pr"v#"ai#"lative iite of nique is to pass an endoscope,t.r"l"*ff],"t1*ugh techwhich a grasping forceps is placed fr";;i;hil th" duodenum into ihe pl"ito''""i.u,,iiil;;rft .toma.h o" (with lap_ argscopig guidance) a portion r*"it"r", *ii.f, is then retracted onto the nerforation. "f The pai.fr'i'. .""*"a

ilive method, has been employed' A flexible fiberoptic grstroscope is passed into the stomach, which is dis' E*a"a *iitt air. The lighted tip of the scope iB impacted othe gastric wall. A second operator passes a catheter

Srough a percutaneous stab wound, aiming at the

Uansilluminated gastioscopetip. Gastrostomy is often

procedure' ;rerformed as an adjunct to a more extensive debilitated patient, gastrostomy may be performecl foa miler local anesthesia.

Ftocedure

A gastrostomy (feeding) as an isolated, procedure is p*ormed thiough a limited transverse left uppe-r ab-

{r1wn. Vagotomy rnuv tt u"*pJ"r:oilil: described "" Vagoiomt:..,.rron ctraln may be placed..AftLr release toneum, the ports are closed i" "fpri"t_"p#tir"-".""irri#rr""_

endoscopic suture or staptes-,

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fominal incision. The peritoneal cavity is entered, the gastric wall is identified, and concentric purse-string lc*u" are placed. A small incision is made into the rtomacb (wilhin the innermost purse-string suture) ftough which a catheter is passed. The purse-string mture" 41s seured. The catheter can exit through the

Hsion or preferably a separate stab wound. The gastic wall is iutured at a few points to the peritoneal surFteporotion of the Potient the patient is supine; arms may be extended
Skin Preporotion
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fice of the stab wound. The abdomen is closed in layers'

Preporotion of the potient, Skin r-reporotion,,Droping, Equipment. rnsTruments, Supplies ond Speciol Notes
See Laparoscopic V.agotomy, pp. 110_112.

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boards. Apply electrosurgical dispersive pad.

GASTROSTOMY

Definition

Begin at the incision (usually transverse left uqPer abdinal) extending from nipples to upper thighs; and &mn to the table at the sides.

*iti;;;;;'#ffi :f tfl:1:tl'"Hilfi '*'.lthestomach

Discussion

Establishment of an ar

Itroping
Folded towels and a transverse sheet

Equipment

A gastrostomv, either temporary or permanent, is used to drain the stomach n" ioi i for pa_ tients-with esophageal "tto* st"i"t""" t**""litcatheter (e.g., Foley) maintains:l: "i p";;;9;"f tract. Recently, percutaneous gastroston

$rction

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Hectrosurgical unit

Hrumentotion
lf,ajor procedures tray
Eemoclip appliers

a nonopera_